Some (semi-rhetorical) questions about capacity

BOP presents several ways to think about capacity that I’ll first summarize in order to get to my questions.  All of the quotes below can be found in BOP, pp. 82-86.

The rest of this post continues below the fold.

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Starting at the top

The issue of core human competences was introduced by Tony Putman in an earlier comment.  One of the interesting related sidelights suggested by this idea is the concept of talents or powers.  My recollection is that Pete Ossorio referred to a talent as a competence that cannot be explained on the basis of prior experience.

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Getting to know “Getting to know you”

The topic of empathy is an excuse for me to consider and summarize issues of embodiment and to encourage discussion.  Empathy is only an example used to illustrate the numbered issues below.  The same concerns hold relative to many person characteristics (though not all), of which empathy is only one (for example, on one side of some hypothetical relationship, openness, inclusiveness, and flexibility, and on the other, optimism, resilience, and loyalty.)

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DP and a dementia rating scale

In “Becoming a non-person” I asked about what capacities are successively lost, from a DP perspective, as a person deteriorates into the neurological ravages of AD.  In an earlier post, Tony referred to “observation” as a core human competence.   In effect, the “Becoming a non-person” exercise was based on my own curiosity about what core human competences are successively lost by a person with dementia  that seem  most directly an expression of neurological capacities?  In other words, I was interested in what observations based on DP could tell us about certain capacities that are provided for neurologically.

There have been several really interesting comments by Richard, Pat and Tony in response to that post.  Being a person entails being able to act in certain ways, to adopt behavioral stances, and to enter into communities.  Being a person requires a history of deliberate action in a dramaturgical pattern.  As dementia progresses, these competences are lost.  Pat and Richard also both noted that being a person is to be seen by others as acting in the ways a person acts (although as Pat mentioned, observer/critics can be wrong.)   The transition to non-person may take place when caregivers can no longer cope effectively with their loved one’s decline (e.g., too emotionally or physically demanding to manage every day).  I hope that Richard, Pat, Tony and others will continue to comment on this.

In addition to that earlier general question, there is a parallel question.  If DP can describe, in some sort of graded fashion, the characteristics of decline, then it seems to me that an informative dementia rating scale of some sort could be devised using DP concepts.  In fact, it may be that such a scale  could be informative not only as a way of demarcating ranges of clinical decline, but also as a tool to guide management, family planning, and intervention approaches.

There are so many scales for rating AD that they’d be hard even to count at this point.  However, they fall into several sub-types.  Leaving aside medical rating scales, there are scales that assess:

(a)  cognitive function (e.g. a variety of full neuropsychological evaluations including automated batteries like the CANTAB (http://www.thinkingahead.info/camcog/default.asp);  dementia rating scales such as the Mattis DRS or the Folstein MMSE);

(b) what are called ‘instrumental activities of daily living’ (e.g.,  the Blessed Dementia Scale (http://www.strokecenter.org/trials/scales/blessed_dementia.html) or the Instrumental Activities of Daily Living Scale (http://www.aafp.org/afp/2002/0601/p2263.html);

(c) psychiatric changes  (e.g., Geriatric Depression Scale (http://www.stanford.edu/~yesavage/GDS.english.short.html) or the Neuropsychiatric Inventory Questionnaire (http://www.aafp.org/afp/2002/0601/p2263.html); and many, many others.

Clearly, the field is crowded.

However, it seems to me it is worth asking whether or not an observational rating scale could be constructed that is based on DP.

For example, at the earliest stages of decline, as Richard suggested, does a declining person lose the ability first to act as a Critic, followed by Observer, and then followed by Actor (the latter certainly seeming to make descriptive sense at the point when, as he has noted, even going to the bathroom independently is not possible?)   By the way, on the surface, this approach appeals to me because there may be a direct associations between loss of these behavioral stances and ways we talk about decline in the neuropsychology world.  For example,  decline of the Observer stance ( in part captured by the K parameter) is akin to decline of certain cognitive skills like memory.  Decline of the Critic stance (in part also captured by the S parameter and the observer/critic’s ability to recognize the recursive features of certain behaviors)  is akin to decline of executive skills.  Perhaps this does some fundamental damage to the A-O-C concepts themselves, which are not categories of behavior but, themselves, recursively associated stances – but for now, this is just an exercise.

Or would it make more sense to rate decline in terms of the IA parameters themselves?  In early stages perhaps a declining person loses competence that we would say are values of the K parameter, in middle stages the W parameter and/or S parameter, and at the latest stages the KH and P parameter?

Or perhaps the best way to describe the loss of core human competences is by noting the type of behavior that is lost, so that, for example, in middle stages an observer might note deficits that would  best be described as impairments of Deliberate Action, while at the latest stages declines might best be described using Performance descriptions?

Or perhaps the concepts that would be most productive to focus on are those that call attention to relationships and communities, such as social practice descriptions.  Perhaps in the earliest stages of AD, social practices are engaged in incorrectly (i.e., atypical versions), but are still recognizable as social practices of a certain kind, while at later stages even the competence to engage in intrinsic social practices is lost (“That’s just not Mom anymore.”)?

In what ways would DP provide a different approach to a clinical rating scale that provide systematic, reliable and meaningful guidance, by identifying patterns in the loss of core human competences that have direct neurological implications?

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Becoming a non-person. Becoming a person.

Alzheimer’s Disease (which, by the way, is very much not my speciality area) is characterized by progressive decline.  In early stages, we might say, “that  person has impairments.”  In middle stages, we might say, “that is a case of a deficient person.”  In later stages, we might say, “that individual is no longer a person” (apart from the consideration that they will always, ethically, be a person because they were once a person, and perhaps one that you loved.) Continue reading

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Getting to know you

Danziger, Faillenot, & Peyron (2009) report some interesting findings about empathy.  Their study relates directly to my earlier post about mirror neurons – a topic that continues to receive a great deal of theoretical and empirical attention.

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On “providing for” …

We have been using the phrase “provide for” to talk about the relationship between embodiment – particularly neurologic embodiment – and behavior. Embodiment provides for behavior. But what are we saying when we say something “provides for” behavior? Perhaps two examples will be helpful.

The first is Anscombe’s old familiar “Saving the Country” image. Ossorio used this decades ago to illustrate Significance: how the same performance can in fact accomplish many things simultaneously, and how the different accomplishments are linked by asking “What is he doing by doing that?” Here I want to turn it on its head, to see how it illustrates “providing for.” Continue reading

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